[Sidenote: What is the use of the question, Is he better?]
There is no more silly or universal question scarcely asked than this,
"Is he better?" Ask it of the medical attendant, if you please. But of
whom else, if you wish for a real answer to your question, would you
ask? Certainly not of the casual visitor; certainly not of the nurse,
while the nurse's observation is so little exercised as it is now. What
you want are facts, not opinions--for who can have any opinion of any
value as to whether the patient is better or worse, excepting the
constant medical attendant, or the really observing nurse?
The most important practical lesson that can be given to nurses is to
teach them what to observe--how to observe--what symptoms indicate
improvement--what the reverse--which are of importance--which are of
none--which are the evidence of neglect--and of what kind of neglect.
All this is what ought to make part, and an essential part, of the
training of every nurse. At present how few there are, either
professional or unprofessional, who really know at all whether any sick
person they may be with is better or worse.
The vagueness and looseness of the information one receives in answer to
that much abused question, "Is he better?" would be ludicrous, if it
were not painful. The only sensible answer (in the present state of
knowledge about sickness) would be "How can I know? I cannot tell how he
was when I was not with him."
I can record but a very few specimens of the answers[1] which I have
heard made by friends and nurses, and accepted by physicians and
surgeons at the very bed-side of the patient, who could have
contradicted every word, but did not--sometimes from amiability, often
from shyness, oftenest from languor!
"How often have the bowels acted, nurse?" "Once, sir." This generally
means that the utensil has been emptied once, it having been used
perhaps seven or eight times.
"Do you think the patient is much weaker than he was six weeks ago?" "Oh
no, sir; you know it is very long since he has been up and dressed, and
he can get across the room now." This means that the nurse has not
observed that whereas six weeks ago he sat up and occupied himself in
bed, he now lies still doing nothing; that, although he can "get across
the room," he cannot stand for five seconds.
Another patient who is eating well, recovering steadily, although
slowly, from fever, but cannot walk or stand, is represented to the
doctor as making no progress at all.
[Sidenote: Leading questions useless or misleading.]
Questions, too, as asked now (but too generally) of or about patients,
would obtain no information at all about them, even if the person asked
of had every information to give. The question is generally a leading
question; and it is singular that people never think what must be the
answer to this question before they ask it: for instance, "Has he had a
good night?" Now, one patient will think he has a bad night if he has
not slept ten hours without waking. Another does not think he has a bad
night if he has had intervals of dosing occasionally. The same answer
has, actually been given as regarded two patients--one who had been
entirely sleepless for five times twenty-four hours, and died of it, and
another who had not slept the sleep of a regular night, without waking.
Why cannot the question be asked, How many hours' sleep has ---- had?
and at what hours of the night?[2] "I have never closed my eyes all
night," an answer as frequently made when the speaker has had several
hours' sleep as when he has had none, would then be less often said.
Lies, intentional and unintentional, are much seldomer told in answer to
precise than to leading questions. Another frequent error is to inquire
whether one cause remains, and not whether the effect which may be
produced by a great many different causes, _not_ inquired after,
remains. As when it is asked, whether there was noise in the street last
night; and if there were not, the patient is reported, without more ado,
to have had a good night. Patients are completely taken aback by these
kinds of leading questions, and give only the exact amount of
information asked for, even when they know it to be completely
misleading. The shyness of patients is seldom allowed for.
How few there are who, by five or six pointed questions, can elicit the
whole case, and get accurately to know and to be able to report _where_
the patient is.
[Sidenote: Means of obtaining inaccurate information.]
I knew a very clever physician, of large dispensary and hospital
practice, who invariably began his examination of each patient with "Put
your finger where you be bad." That man would never waste his time with
collecting inaccurate information from nurse or patient. Leading
questions always collect inaccurate information.
At a recent celebrated trial, the following leading question was put
successively to nine distinguished medical men. "Can you attribute these
symptoms to anything else but poison?" And out of the nine, eight
answered "No!" without any qualification whatever. It appeared, upon
cross-examination:--1. That none of them had ever seen a case of the
kind of poisoning supposed. 2. That none of them had ever seen a case of
the kind of disease to which the death, if not to poison, was
attributable. 3. That none of them were even aware of the main fact of
the disease and condition to which the death was attributable.
Surely nothing stronger can be adduced to prove what use leading
questions are of, and what they lead to.
I had rather not say how many instances I have known, where, owing to
this system of leading questions, the patient has died, and the
attendants have been actually unaware of the principal feature of the
case.
[Sidenote: As to food patient takes or does not take.]
It is useless to go through all the particulars, besides sleep, in which
people have a peculiar talent for gleaning inaccurate information. As to
food, for instance, I often think that most common question, How is your
appetite? can only be put because the questioner believes the questioned
has really nothing the matter with him, which is very often the case.
But where there is, the remark holds good which has been made about
sleep. The _same_ answer will often be made as regards a patient who
cannot take two ounces of solid food per diem, and a patient who does
not enjoy five meals a day as much as usual.
Again, the question, How is your appetite? is often put when How is your
digestion? is the question meant. No doubt the two things depend on one
another. But they are quite different. Many a patient can eat, if you
can only "tempt his appetite." The fault lies in your not having got him
the thing that he fancies. But many another patient does not care
between grapes and turnips--everything is equally distasteful to him. He
would try to eat anything which would do him good; but everything "makes
him worse." The fault here generally lies in the cooking. It is not his
"appetite" which requires "tempting," it is his digestion which requires
sparing. And good sick cookery will save the digestion half its work.
There may be four different causes, any one of which will produce the
same result, viz., the patient slowly starving to death from want of
nutrition: